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Stutvoet MD, Levelt L, Hrehovcsik MM, Van't Veer J, Visch VT, Bramer WM, Hillegers MHJ, Veltkamp RC, Nijhof SL, Estévez-López F. Gamification in eHealth for Chronic Disease Self-Management in Youth: A Systematic Review. Games Health J 2024; 13:314-331. [PMID: 38900649 DOI: 10.1089/g4h.2023.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Abstract
This systematic review primarily aims to provide a summary of the game mechanics implemented in eHealth tools supporting young people's self-management of their chronic diseases. This review secondarily investigates the rationale for implementing game mechanics and the effects of these tools. A systematic search was conducted in Embase, Medline, PsycINFO, and Web of Science, from inception until August 30, 2022. Studies were eligible if focus was on the utilization of gamification in eHealth self-management interventions for young people (age = 10-25 years) with chronic diseases. Primary quantitative, qualitative, and mixed-method studies written in English were included. We identified 34 eHealth tools, of which 20 (59%) were gamified tools and 14 (41%) were serious games. We found that 55 unique game mechanics were implemented. The most commonly used were rewards (50%), score (44%), creative control (41%), and social interaction (32%). In comparison with gamified tools, the number and diversity of game mechanics applied were higher in serious games. For most tools (85%), a general rationale was provided for utilizing gamification, which often was to promote engaging experiences. A rationale for using specific game mechanics was less commonly provided (only for 45% of the game mechanics). The limited availability of experimental research precludes to test the effectiveness of using gamification in eHealth to support self-management in young people with chronic diseases. In this study, we highlight the importance of reporting the rationale for utilizing specific game mechanics in eHealth tools to ensure a proper alignment with evidence-based practice and the need of conducting experimental research. PROSPERO: CRD42021293037.
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Affiliation(s)
- Maartje D Stutvoet
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lisa Levelt
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | | | - Job Van't Veer
- Department of Healthcare, NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands
| | - Valentijn T Visch
- Department of Human Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Remco C Veltkamp
- Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sanne L Nijhof
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Fernando Estévez-López
- Department of Education, Faculty of Education Sciences; SPORT Research Group (CTS-1024); and CIBIS (Centro de Investigación para el Bienestar y la Inclusión Social) Research Center, University of Almería, Almería, Spain
- Biomedical Research Unit, Torrecárdenas University Hospital, Almería, Spain
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Clark OE, Smith ZR, Hilderbrand T, Holmbeck GN. Growth of condition-related knowledge among youth with spina bifida: associations with neurocognitive functioning and self-management skills. J Pediatr Psychol 2024; 49:449-458. [PMID: 38216130 PMCID: PMC11258814 DOI: 10.1093/jpepsy/jsad097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/28/2023] [Accepted: 12/21/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE This study aims to characterize the growth in condition-related knowledge in youth with spina bifida (SB), identify neurocognitive predictors of growth, and examine associations between growth in knowledge and subsequent levels of medical self-management skills. METHODS Participants were recruited from a larger longitudinal study involving 140 youth with SB and caregivers, who completed questionnaires and interviews every 2 years over 8 years. The current study included the youth report of condition-related knowledge and medical self-management skills. Youth attention and executive functioning were assessed via parent and teacher reports and performance-based assessment. Latent growth curves were conducted in Mplus Version 8 (Múthen, L. K., & Múthen, B. O. [1998]. Mplus User's Guide. [Eighth]. Muthén & Muthén) to examine change over time in youth-reported condition-related knowledge. Neurocognitive variables were included as predictors of growth in knowledge and regression analyses were used to predict medical self-management skills from growth in condition-related knowledge. RESULTS Youth condition-related knowledge increased linearly. Better youth performance on working memory and attention performance-based tasks predicted a higher intercept for condition-related knowledge at T1, but not slope. Teacher and parent reports of inattention and executive dysfunction were not consistent predictors of intercept and growth. Slope of condition-related knowledge was not predictive of subsequent youth self-management skills. CONCLUSIONS Youth with SB gain condition-related knowledge over time. However, executive dysfunction and inattention may impede gains in condition-related knowledge. Thus, executive functioning supports, attention-related interventions, and psychoeducation may support condition-related knowledge gains and later medical self-management skills, but further research assessing family and cultural factors is needed.
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Affiliation(s)
- Olivia E Clark
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Zoe R Smith
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
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Walter LP, Göldel JM, Warschburger P. The Protective Role of Self-Regulation for HRQOL of Adolescents with a Chronic Physical Health Condition. Prax Kinderpsychol Kinderpsychiatr 2024; 73:311-330. [PMID: 38840539 DOI: 10.13109/prkk.2024.73.4.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
The Protective Role of Self-Regulation for HRQOL of Adolescents with a Chronic Physical Health Condition A physical chronic condition comes with many challenges and negatively impacts the healthrelated quality of life (HRQOL) of those affected. Self-regulation plays an important role in successfully coping with the demands of a chronic condition. In line with a resource-oriented approach, this study aimed to investigate themoderating effect of self-regulation on the relationship between disease severity andHRQOL. For this, 498 adolescents with cystic fibrosis, juvenile idiopathic arthritis, or type-1 diabetes aged of 12-21 years (M= 15.43, SD= 2.07) were recruited through three patient registers. Subjective disease severity, self-regulation (Brief Self-Control- Scale), andHRQOL (DISABKIDSChronicGenericMeasure)were examined at two time points (T₁ and T₂, one year apart). Cross-sectional analysis showed significant effects of subjective disease severity and self-regulation on HRQOL. Prospective analysis, in which HRQOL at T₁ was controlled for, revealed that disease severity only predicted emotion-related HRQOL at T₂; selfregulation emerged as a predictor for HRQOL subscales independence, emotion, inclusion, exclusion, and treatment. A significantmoderation effect of self-regulation was found on the relationship between disease severity and HRQOL emotion. Our results highlight the positive impact of self-regulation on quality of life, specifically in the context of chronic conditions and represent a starting point for prevention and intervention approaches.
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Conour CN, Sugiwaka H, Nelson CI, Duncan CL. Self-Control in Pediatric Migraine Management: A Topical Review. J Pediatr Psychol 2024; 49:107-110. [PMID: 37949096 DOI: 10.1093/jpepsy/jsad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/28/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE This review examines the role that two types of self-control may play in youth's self-management of migraine. Although traditionally conceptualized from an inhibitory lens, self-control has both initiatory and inhibitory functions, and the authors suggest the distinction is important in relation to youth's ability to adhere to different components of migraine treatment regimens. METHODS A topical review of the literature was conducted to identify evidence-based interventions to treat pediatric migraine and conceptualize the role self-control (both initiatory and inhibitory) may play in adherence to its regimen. Both PsycInfo and PubMed databases were used to identify relevant articles. RESULTS Existing evidence-based interventions and recommendations for pediatric migraine require inhibitory self-control (e.g., avoiding caffeine, tobacco) and initiatory self-control (e.g., taking medication). Formal intervention programs (e.g., cognitive behavioral therapy) tend to employ initiatory self-control (e.g., modifying physical reactions in response to biofeedback). CONCLUSIONS Understanding the distinct types of self-control required for adherence to different interventions allows for a better conceptualization of self-management of pediatric migraine. Individuals may struggle with adherence when they have deficits in one or both types of self-control skills. Future research should consider whether self-control is associated with differential adherence patterns in pediatric migraine management.
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Brolin R, Hanson E, Magnusson L, Lewis F, Parkhouse T, Hlebec V, Santini S, Hoefman R, Leu A, Becker S. Adolescent Young Carers Who Provide Help and Support to Friends. Healthcare (Basel) 2023; 11:2876. [PMID: 37958020 PMCID: PMC10649303 DOI: 10.3390/healthcare11212876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Prior studies emphasize the value of friends' support for children/adolescents who have a disability or suffer from mental ill-health or a long-term illness. However, few studies have explored how a caring role affects those young friend carers themselves. This paper addresses a gap in the research by focusing on this hitherto neglected group of young carers to explore the impact of providing care to friends. An online survey was employed for a cross-national study conducted in 2018-2019 in Sweden, Italy, Slovenia, the Netherlands, Switzerland, and the United Kingdom to examine the incidence of adolescent young friend carers, the extent of care they provide, and their self-reported health, well-being, and school situation. The survey was completed by 7146 adolescents, aged 15-17, and 1121 of them provided care to a friend with a health-related condition, most frequently mental ill-health. They carried out high levels of caring activities, and a quarter of them also provided care to a family member. They experienced both positive and negative aspects of caring. Nevertheless, in comparison with adolescents who provided care to family members, they reported more health problems, with a dominance of mental ill-health, and they received lower levels of support. Since adolescent friends play a valuable role for young people with health-related conditions, especially mental ill-health, it is important to find ways of optimizing their caring experiences in order that those adolescents who choose to care for a friend can do so without it having a negative impact on their own mental health, well-being, and life situation.
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Affiliation(s)
- Rosita Brolin
- Department Health and Caring Sciences, Linnaeus University, SE-39182 Kalmar, Sweden;
| | - Elizabeth Hanson
- Department Health and Caring Sciences, Linnaeus University, SE-39182 Kalmar, Sweden;
- The Swedish Family Care Competence Centre, Strömgatan 13, SE-39232 Kalmar, Sweden
| | - Lennart Magnusson
- Department Health and Caring Sciences, Linnaeus University, SE-39182 Kalmar, Sweden;
- The Swedish Family Care Competence Centre, Strömgatan 13, SE-39232 Kalmar, Sweden
| | - Feylyn Lewis
- School of Nursing 179, Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA;
| | - Tom Parkhouse
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QQ, UK;
| | - Valentina Hlebec
- Faculty of Social Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Sara Santini
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA-National Institute of Health and Science on Ageing, 60124 Ancona, Italy;
| | - Renske Hoefman
- The Netherlands Institute for Social Research (SCP), Postbus 16164, 2500 BD The Hague, The Netherlands;
| | - Agnes Leu
- Institute for Biomedical Ethics, Science and Medical Faculty, University of Basel, 4001 Basel, Switzerland;
| | - Saul Becker
- School of Education and Social Work, University of Sussex, Falmer, Brighton BN1 9QQ, UK;
- Faculty of Health and Education, Manchester Metropolitan University, Manchester M15 6BX, UK
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Vale MF, Camargo-Júnior EB, Magalhães FAC, de Almeida-Júnior JJ, Gherardi-Donato ECDS, Fernandes MNDF. Risk factors for the population's mental health amidst the COVID-19 pandemic. Rev Esc Enferm USP 2023; 57:e20220324. [PMID: 37470726 PMCID: PMC10409497 DOI: 10.1590/1980-220x-reeusp-2022-0324en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/25/2023] [Indexed: 07/21/2023] Open
Abstract
OBJECTIVE To identify risk factors for mental health in the population in times of COVID-19 through the analysis of levels of socio-cognitive mindfulness and perception of stress in individuals. METHOD This is a cross-sectional observational study with a quantitative approach, carried out through online data collection using the Perceived Stress Scale and the Langer Mindfulness Scale in a sample of 955 individuals from different regions of Brazil. RESULTS Women, younger people and individuals with low socioeconomic conditions had higher levels of perceived stress; on the other hand, older men and individuals with high socioeconomic status had higher levels of mindfulness. CONCLUSION Socio-cognitive mindfulness was not a protective factor for perceived stress in the context of the COVID-19 pandemic.
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Sayegh CS, Iverson E, Newman C, Tanaka D, Olshansky EF, Wijaya C, Belzer M. Designing an mHealth Roadmap for the Journey to Self-Management: A Qualitative Study with Adolescents and Young Adults Living with Chronic Illness. Chronic Illn 2023; 19:65-80. [PMID: 34904870 DOI: 10.1177/17423953211067436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Adolescents and young adults (AYA) with chronic illnesses often struggle with illness self-management. The objective of this study is to understand how AYA with various chronic illnesses develop self-management skills and which mobile health (mHealth) strategies they believe could be helpful. METHODS Semi-structured interviews were conducted with patients, between 16 to 20 years old, living with at least one chronic illness (N = 19), between 2018 and 2019 in Los Angeles, CA. Three coders completed thematic coding to understand how AYA develop and maintain self-management skills, to inform the development of mHealth interventions appropriate across a variety of chronic conditions. RESULTS Results suggest that AYA develop self-management skills through several strategies, including (1) getting organized, (2) making it work for me and (3) keeping the right mentality. AYA described developing these strategies through: (1) receiving social support, (2) accessing helpful tools and technologies, and (3) going through a maturation process. They provided recommendations for mHealth intervention developers. DISCUSSION The results suggest that an appealing mHealth intervention could support AYA patients in proactively acquiring self-management skills and prevent having to rely on trial and error or uneven access to guidance and support. Interventions should be responsive to individual technology preferences and practices.
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Affiliation(s)
- Caitlin S Sayegh
- Division of Adolescent and Young Adult Medicine, 5150Children's Hospital Los Angeles, Los Angeles, California, USA.,USC University Center for Excellence in Developmental Disabilities, 5150Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, 12223University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ellen Iverson
- Division of Adolescent and Young Adult Medicine, 5150Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, 12223University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Clarissa Newman
- Department of Population and Public Health Sciences, 12223University of Southern California, Los Angeles, California, USA
| | - Diane Tanaka
- Division of Adolescent and Young Adult Medicine, 5150Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, 12223University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ellen F Olshansky
- 115162Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA.,Sue & Bill Gross School of Nursing, 8788University of California Irvine, Los Angeles, California, USA
| | - Clarisa Wijaya
- Department of Psychology, 5116University of Southern California, Los Angeles, California, USA
| | - Marvin Belzer
- Division of Adolescent and Young Adult Medicine, 5150Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, 12223University of Southern California Keck School of Medicine, Los Angeles, California, USA
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Dai WS, Lin WH, Lin SH, Chen Q, Cao H. Postoperative health-related quality of life in children with congenital heart disease: a short-term follow-up study. J Cardiothorac Surg 2023; 18:17. [PMID: 36631875 PMCID: PMC9832600 DOI: 10.1186/s13019-023-02110-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 01/02/2023] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE This study aimed to explore changes in health-related quality of life in children with congenital heart disease from pre-surgery to 6 months after surgery. METHODS A total of 87 children aged 2-12 years who underwent cardiac surgery in a provincial hospital in China from January 2021 to June 2021 were selected. After 6 months, the quality of life of all children was retrospectively analyzed. The Chinese version of the Pediatric Quality of Life Inventory 4.0 Scale was used to assess the quality of life of children before and after surgery. RESULTS Parents of 85 children and 33 children aged 5-12 years completed the questionnaires. After surgical treatment, the quality of life scores reported by parents of children of all ages were significantly higher than those before surgery, the P value < 0.05; the self-evaluated quality of life scores of children of different ages were significantly higher than those before surgery, the P value < 0.05. CONCLUSION Surgical treatment can improve the health-related quality of life of children with congenital heart disease.
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Affiliation(s)
- Wang-Sheng Dai
- grid.256112.30000 0004 1797 9307Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Wen-Hao Lin
- grid.256112.30000 0004 1797 9307Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shi-Hao Lin
- grid.256112.30000 0004 1797 9307Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- grid.256112.30000 0004 1797 9307Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hua Cao
- grid.256112.30000 0004 1797 9307Department of Cardiac Surgery, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Stapleton C, Watkins E, Hare MJL, Timms F, Wood AJ, Titmuss A. The prevalence of diabetes distress and its association with glycaemia in young people living with insulin-requiring-diabetes in a regional centre in Australia. J Paediatr Child Health 2022; 58:2273-2279. [PMID: 36206303 PMCID: PMC10092535 DOI: 10.1111/jpc.16221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 01/09/2023]
Abstract
AIM Emotional responses, such as feeling overwhelmed with diabetes-related treatment, burnt-out and anxiety, are known as 'diabetes distress'. This study aimed to determine diabetes distress among children, adolescents and parents/carers managing insulin-requiring diabetes in a regional Australian setting, and to assess association with glycaemia. METHODS All children, adolescents and their parents/carers attending a regional hospital outpatient diabetes clinic between March 2018 and June 2019 were invited to complete a validated child, adolescent or parent/carer diabetes distress questionnaire. Demographics and time-matched clinical data were obtained from hospital records. A cross-sectional analysis was performed. RESULTS A total of 43 young people and 30 parents/carers completed a diabetes distress questionnaire during the study period. Diabetes distress was common, with 63% of young people and 67% of parents/carers nominating at least one serious concern. After adjustment for potential confounding factors, higher glycaemia (HbA1c %) was associated with higher distress scores among both young people (ß 6.2, 95% confidence interval (CI): 3.2-9.2, P < 0.001) and carers/parents (ß 5.6, 95% CI:1.5-9.8, P < 0.001). Diabetes distress did not differ by child age, duration of diagnosis or mode of insulin administration. For children, adolescents and carers, 'serious concerns' most commonly related to the impact of diabetes upon family and peer relationships. CONCLUSIONS Diabetes distress was common and associated with sub-optimal glycaemia. Routine screening for diabetes distress should be considered in paediatric services. Development of strategies to minimise diabetes distress for youth and families is required.
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Affiliation(s)
- Ciara Stapleton
- Paediatric Department, Division of Women, Children and YouthRoyal Darwin HospitalDarwinNorthern TerritoryAustralia
| | - Elizabeth Watkins
- Endocrinology Department, Division of MedicineRoyal Darwin HospitalDarwinNorthern TerritoryAustralia
| | - Matthew J L Hare
- Endocrinology Department, Division of MedicineRoyal Darwin HospitalDarwinNorthern TerritoryAustralia
- Wellbeing and Preventable Chronic Diseases DivisionMenzies School of Health Research, Charles Darwin UniversityDarwinNorthern TerritoryAustralia
| | - Francesca Timms
- Endocrinology Department, Division of MedicineRoyal Darwin HospitalDarwinNorthern TerritoryAustralia
| | - Anna J Wood
- Endocrinology Department, Division of MedicineRoyal Darwin HospitalDarwinNorthern TerritoryAustralia
- Wellbeing and Preventable Chronic Diseases DivisionMenzies School of Health Research, Charles Darwin UniversityDarwinNorthern TerritoryAustralia
| | - Angela Titmuss
- Paediatric Department, Division of Women, Children and YouthRoyal Darwin HospitalDarwinNorthern TerritoryAustralia
- Wellbeing and Preventable Chronic Diseases DivisionMenzies School of Health Research, Charles Darwin UniversityDarwinNorthern TerritoryAustralia
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Miller AL, Albright D, Bauer KW, Riley HO, Hilliard ME, Sturza J, Kaciroti N, Lo SL, Clark KM, Lee JM, Fredericks EM. Self-Regulation as a Protective Factor for Diabetes Distress and Adherence in Youth with Type 1 Diabetes During the COVID-19 Pandemic. J Pediatr Psychol 2022; 47:873-882. [PMID: 35609567 PMCID: PMC9213854 DOI: 10.1093/jpepsy/jsac045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic increased economic, social, and health stressors for families, yet its impacts on families of youth with chronic conditions, such as type 1 diabetes (T1D), are not well understood. Self-regulation (SR)-or the capacities to control emotions, cognition, and behavior in response to challenge-is known to support T1D management and coping in the face of stress. Strong SR may have protected youth with T1D from the impacts of pandemic-related stressors. This study compared youth and parent emotional functioning and T1D management before and after the pandemic's onset in relation to family pandemic-related stress and youth SR. METHODS Parents of youth with T1D (N = 88) and a subset of these youth (N = 43; Mean age 15.3 years [SD 2.2]) completed surveys regarding SR, stress, emotional functioning, and T1D-related functioning prior to and after March 2020. Outcomes were compared using mixed effects models adjusting for covariates. Family pandemic-related stress experiences and youth SR were tested as moderators of change. RESULTS Parents' responsibility for T1D management increased across pandemic onset and their diabetes-related distress decreased. Family pandemic-related stress was associated with decreased emotional functioning over time. Youth SR, particularly emotional and behavioral aspects, predicted better emotional and T1D-related functioning. DISCUSSION While youth with T1D whose families experienced higher pandemic-related stress had poorer adjustment, strong emotional and behavioral SR appeared to protect against worsening youth mood and adherence across pandemic onset. Both social-contextual and individual factors are important to consider when working with families managing T1D.
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Affiliation(s)
- Alison L Miller
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Dana Albright
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Hurley O Riley
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - Julie Sturza
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Niko Kaciroti
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sharon L Lo
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Katy M Clark
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Joyce M Lee
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
| | - Emily M Fredericks
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
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Clayton-Jones D, Ong LZ, Garnier-Villarreal M, Vick L, Sawdy R, George S, Haglund K. Complementary and Alternative Medicine Mind-Body Approaches Used Among Racially and Ethnically Diverse Adolescents. J Pediatr Nurs 2021; 61:254-259. [PMID: 34329828 DOI: 10.1016/j.pedn.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this paper is to examine complementary and alternative medicine (CAM) use among racially and ethnically diverse adolescents. Greater understanding of CAM use among this group is warranted to better inform health care providers in delivering a culturally relevant health promotion approach. DESIGN AND METHODS A secondary data analysis was conducted using the 2012 Child Complementary and Alternative Medicine Supplement of the National Health Interview Survey (CAM-NHIS) data, which was collected from a national sample of adolescents aged 12-17 years. A logistic regression test was employed to investigate the predictors associated with CAM use among racially and ethnically diverse adolescents. RESULTS While Black and Hispanic adolescents were the least likely to use CAM compared to their White counterparts, families with higher incomes, higher education attainment, and adolescents who experienced pain were more likely to use CAM. CONCLUSIONS Findings suggest the need for future research to gain a greater understanding of CAM use among racially and ethnically diverse adolescents, and insights into how health disparities impact CAM use. Greater understanding of how CAM use intersects with health beliefs and outcomes is also warranted. PRACTICE IMPLICATIONS Based on the CAM-NHIS survey, few racially and ethnically diverse adolescents have reported use of CAM. Development of culturally appropriate instruments and methods to assess CAM use among racially and ethnically diverse adolescents may yield specific data for this population. Informed health care providers can advocate for improved access to CAM for minority adolescents and alter disparate use.
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Affiliation(s)
| | - Lee Za Ong
- Marquette University, Department of Counselor Education and Counseling Psychology, WI, USA.
| | | | - Lori Vick
- University of South Carolina College of Nursing, SC, USA.
| | - Rachel Sawdy
- Marquette University College of Nursing, WI, USA.
| | - Safiya George
- Christine E. Lynn College of Nursing, Florida Atlantic University, FL, USA.
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Hall R, Keeble L, Sünram-Lea SI, To M. A review of risk factors associated with insulin omission for weight loss in type 1 diabetes. Clin Child Psychol Psychiatry 2021; 26:606-616. [PMID: 34121470 PMCID: PMC8264633 DOI: 10.1177/13591045211026142] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Research suggests that as many as 60% of people with type 1 diabetes (T1D) admit to misusing insulin. Insulin omission (IO) for the purpose of weight loss, often referred to as diabulimia, is a behaviour becoming increasingly recognised, not least since prolonged engagement can lead to serious vascular complications and mortality. Several risk factors appear to be relevant to the development of IO, most notably gender, anxiety and depression and increased weight concerns and body dissatisfaction. Evidence suggests that women, especially young girls, are more likely to omit insulin as a method of weight loss compared to men. Mental health conditions such as anxiety and depression are increasingly prevalent in people with T1D compared to their peers, and appear to contribute to the risk of IO. Increased weight concerns and body dissatisfaction are further prominent risk factors, especially given increases in weight which often occur following diagnosis and the monitoring of weight by diabetes teams. This review presents evidence examining these risk factors which increase the likelihood of a person with T1D engaging in IO and highlights the complications associated with prolongment of the behaviour. Further research looking at the comorbidities of these risk factors, alongside other factors, would provide greater insight into understanding IO in people with T1D.
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Affiliation(s)
- Rebecca Hall
- Department of Psychology, 4396Lancaster University, Lancaster, UK
| | - Leanna Keeble
- Department of Psychology, 4396Lancaster University, Lancaster, UK
| | | | - Michelle To
- Department of Psychology, 4396Lancaster University, Lancaster, UK
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13
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Cushing CC, Bejarano CM, Ortega A, Sayre N, Fedele DA, Smyth JM. Adaptive mHealth Intervention for Adolescent Physical Activity Promotion. J Pediatr Psychol 2021; 46:536-546. [PMID: 33484137 DOI: 10.1093/jpepsy/jsaa125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The present nonrandomized controlled trial aimed to evaluate feasibility, acceptability, and preliminary efficacy of a tailored text message intervention for increasing adolescent physical activity, as compared with passive monitoring. METHODS Forty adolescents (13-18 years old) received either a tailored text messaging intervention (Network Underwritten Dynamic Goals Engine [NUDGE]; N = 20), or participated in an attention-control condition (N = 20), for 20 days. Physical activity was measured for all participants via continuous accelerometry. Frequency analyses were conducted on program usage and satisfaction ratings to evaluate feasibility and acceptability, and multilevel models were used to evaluate the efficacy hypotheses. RESULTS The vast majority of participants (90%) reported being very or mostly satisfied with the NUDGE program and rated their enjoyment as above average. The intervention group was estimated to spend an average of 20.84 more minutes per day in moderate-to-vigorous physical activity relative to the attention-control group (β = 20.84, SE = 8.19). Exploratory analyses revealed that the intervention group also engaged in 82 fewer minutes of sedentary time per day on average, although this effect was not significant due to the large variability in sedentary time (β = -81.98, SE = 46.86). CONCLUSIONS The NUDGE tailored text messaging intervention was feasible, acceptable, and efficacious in increasing physical activity in this sample. Findings warrant additional evaluation of NUDGE as both a standalone physical activity intervention or as part of a multicomponent package.
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Affiliation(s)
- Christopher C Cushing
- Schiefelbusch Institute for Life Span Studies, University of Kansas.,Clinical Child Psychology Program, University of Kansas
| | | | - Adrian Ortega
- Clinical Child Psychology Program, University of Kansas
| | | | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida
| | - Joshua M Smyth
- Department of Biobehavioral Health, The Pennsylvania State University
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14
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Lo SL, Gearhardt AN, Fredericks EM, Katz B, Sturza J, Kaciroti N, Gonzalez R, Hunter CM, Sonneville K, Chaudhry K, Lumeng JC, Miller AL. Targeted self-regulation interventions in low-income children: Clinical trial results and implications for health behavior change. J Exp Child Psychol 2021; 208:105157. [PMID: 33910138 DOI: 10.1016/j.jecp.2021.105157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/02/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
Self-regulation, known as the ability to harness cognitive, emotional, and motivational resources to achieve goals, is hypothesized to contribute to health behaviors across the lifespan. Enhancing self-regulation early in life may increase positive health outcomes. During pre-adolescence, children assume increased autonomy in health behaviors (e.g., eating; physical activity), many of which involve self-regulation. This article presents results from a clinical trial (NCT03060863) that used a factorial design to test behavioral interventions designed to enhance self-regulation, specifically targeting executive functioning, emotion regulation, future-oriented thinking, and approach biases. Participants were 118 children (9-12 years of age, M = 10.2 years) who had a history of living in poverty. They were randomized to receive up to four interventions that were delivered via home visits. Self-regulation was assayed using behavioral tasks, observations, interviews, and parent- and child-report surveys. Results were that self-regulation targets were reliably assessed and that interventions were delivered with high fidelity. Intervention effect sizes were very small to moderate (d range = .02-.65, median = .14), and most were not statistically significant. Intercorrelation analyses indicated that associations between measures within each target varied based on the self-regulation target evaluated. Results are discussed with regard to the role of self-regulation-focused interventions in child health promotion. Implications of findings are reviewed for informing next steps in behavioral self-regulation interventions among children from low-income backgrounds.
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Affiliation(s)
- Sharon L Lo
- School of Graduate Psychology, Pacific University, Hillsboro, OR 97123, USA; School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Ashley N Gearhardt
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Emily M Fredericks
- Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Benjamin Katz
- Department of Human Development and Family Science, Virginia Tech, Blacksburg, VA 24061, USA
| | - Julie Sturza
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Niko Kaciroti
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Richard Gonzalez
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kendrin Sonneville
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kiren Chaudhry
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Julie C Lumeng
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alison L Miller
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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15
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Dall’Oglio I, Gasperini G, Carlin C, Biagioli V, Gawronski O, Spitaletta G, Grimaldi Capitello T, Salata M, Vanzi V, Rocco G, Tiozzo E, Vellone E, Raponi M. Self-Care in Pediatric Patients with Chronic Conditions: A Systematic Review of Theoretical Models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3513. [PMID: 33800684 PMCID: PMC8037526 DOI: 10.3390/ijerph18073513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/13/2021] [Accepted: 03/24/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND To improve outcomes in children and young adults (CYAs) with chronic conditions, it is important to promote self-care through education and support. AIMS (1) to retrieve the literature describing theories or conceptual models of self-care in CYAs with chronic conditions and (2) to develop a comprehensive framework. METHODS A systematic literature search was conducted on nine databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All peer-reviewed papers describing a theory or a conceptual model of self-care in CYAs (0-24 years) with chronic conditions were included. RESULTS Of 2674 records, 17 met the inclusion criteria. Six papers included a theory or a model of self-care, self-management, or a similar concept. Six papers developed or revised pre-existing models or theories, while five papers did not directly focus on a specific model or a theory. Patients were CYAs, mainly with type 1 diabetes mellitus and asthma. Some relevant findings about self-care in CYAs with neurocognitive impairment and in those living with cancer may have been missed. CONCLUSIONS By aggregating the key elements of the 13 self-care conceptual models identified in the review, we developed a new overarching model emphasizing the shift of self-care agency from family to patients as main actors of their self-management process. The model describes influencing factors, self-care behaviors, and outcomes; the more patients engaged in self-care behaviors, the more the outcomes were favorable.
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Affiliation(s)
- Immacolata Dall’Oglio
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Giulia Gasperini
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Claudia Carlin
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Valentina Biagioli
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Orsola Gawronski
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Giuseppina Spitaletta
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Teresa Grimaldi Capitello
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Michele Salata
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Valentina Vanzi
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Gennaro Rocco
- Centre of Excellence for Nursing Scholarship-Nursing Professional Order of Rome, Viale Giulio Cesare, 78, 00192 Rome, Italy;
| | - Emanuela Tiozzo
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Massimiliano Raponi
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
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16
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Gauci J, Bloomfield J, Lawn S, Towns S, Steinbeck K. Effectiveness of self-management programmes for adolescents with a chronic illness: A systematic review. J Adv Nurs 2021; 77:3585-3599. [PMID: 33630315 DOI: 10.1111/jan.14801] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/31/2020] [Accepted: 01/16/2021] [Indexed: 12/14/2022]
Abstract
AIM To assess what is known about the effectiveness of face-to-face self-management programmes designed specifically for adolescents (10-19 years) with a chronic illness. DESIGN A systematic review and synthesis without meta-analysis (SWiM). DATA SOURCES Six international web-based reference libraries were searched with a date range of 1946 to July 2020. REVIEW METHOD The PRISMA statement and SWiM guideline were used for reporting the methods and results. The PICO format was used to develop a focused clinical question and the eligibility criteria of our review. Quality assessment of the included studies was performed using the Cochrane Effective Practice Organisation of Care criteria. RESULTS Eight studies (four randomized controlled trials and four descriptive designs) met the inclusion criteria and were published between 2003 and 2017. Results of the review: Three studies demonstrated measures of illness control which showed initial improvements in adherence as a result of the interventions but failed to demonstrate sustained adherence over time. Booster sessions were identified as an effective strategy to improve adherence, but were often omitted. CONCLUSIONS There is a limited body of evidence on the effectiveness of self-management programmes specifically developed for adolescents with a chronic illness, an important but under researched area. Future research lies in the development of more rigorous studies that focus on quantitative outcome measures for evaluating the effectiveness of self-management programmes to guide the development of future programmes. IMPACT It is crucial for adolescents with a chronic illness to develop independence and the self-management skills required to effectively manage their chronic condition as they transition to adulthood. On current evidence, in planning future self-management interventions should include booster sessions. Nurses with additional training and experience have a key role in supporting adolescents with a chronic illness to develop self-management skills as they assume responsibility for their own healthcare.
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Affiliation(s)
- Jaunna Gauci
- Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Discipline of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Jacqueline Bloomfield
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Susan Towns
- Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Discipline of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Katharine Steinbeck
- Discipline of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
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17
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Jennings M, Guilfoyle A, Green J, Cleary Y, Gowran RJ. Octopus Watch Fosters Family Resilience by Enhancing Occupational Engagement for Children with Spina Bifida and/or Hydrocephalus: Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228316. [PMID: 33182784 PMCID: PMC7697938 DOI: 10.3390/ijerph17228316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Children with spina bifida and/or hydrocephalus (SB&/H) often experience difficulties with activities of daily living (ADLs) due to impaired executive functioning, increasing sedentary behaviours. The HeyJoy Octopus watch, a child-friendly icon-based smartwatch could be used as an enabler to promote purposeful ADLs (i.e., goal-orientated ADLs). OBJECTIVE to investigate the effectiveness of the Octopus watch in promoting purposeful ADLs for children living with SB&/H (<8 years). METHODS Mixed-methods engaging parents and children in four phases: (1) Administered demographic questionnaire, semi-structured interview, childhood executive functioning inventory (CHEXI) and the Canadian occupational performance measure (COPM); focus group one introducing the study, information pack using smartwatch and photovoice data collection methods. (2) Measured baseline movement for four days with smartwatch without using functions. (3) Measured activity for 16-days while using the smartwatch. (4) Re-administered assessments and conducted a second focus group based on photovoice narratives. RESULTS movement data recorded for four participants, three of four showed mean activity increase (36%). N-of-1 analyses found one participant showed clear improvement (p = 0.021, r2 = 0.28). Mean inhibition decreased by 16.4%, and mean change in COPM performance and satisfaction scores were 2.1 and 2.4, respectively. The photovoice narrative focus group supports findings evidenced with improved daily routines. CONCLUSIONS The Octopus watch is an innovative early intervention that can promote purposeful ADLs, fostering family resilience by enhancing occupational engagement. Further research is required.
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Affiliation(s)
- Mark Jennings
- Discipline Occupational Therapy, School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, V94 T9PX Limerick, Ireland; (M.J.); (A.G.)
| | - Aoife Guilfoyle
- Discipline Occupational Therapy, School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, V94 T9PX Limerick, Ireland; (M.J.); (A.G.)
| | - James Green
- School of Allied Health, Faculty of Education and Health Sciences, Physical Activity for Health (PAfH), Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland;
| | - Yvonne Cleary
- Technical Communication and Instructional Design, University of Limerick, V94 T9PX Limerick, Ireland;
| | - Rosemary Joan Gowran
- Discipline Occupational Therapy, School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, Health Implementation Science and Technology (HIST), University of Limerick, V94 T9PX Limerick, Ireland
- School of Health and Sports Science, University of the Sunshine Coast, Maroochydore DC QLD 4558, Australia
- Assisting Living and Learning (ALL), Institute Maynooth University, Maynooth, W23 VP22 Co. Kildare, Ireland
- Correspondence:
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18
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Boggiss AL, Consedine NS, Schache KR, Jefferies C, Bluth K, Hofman PL, Serlachius AS. A brief self-compassion intervention for adolescents with type 1 diabetes and disordered eating: a feasibility study. Diabet Med 2020; 37:1854-1860. [PMID: 32614482 DOI: 10.1111/dme.14352] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2020] [Indexed: 02/06/2023]
Abstract
AIM To examine the feasibility and acceptability of a brief self-compassion intervention for adolescents with type 1 diabetes and disordered eating behaviour. METHODS Twenty-seven adolescents with type 1 diabetes were recruited and randomized to receive the brief (two 2.5-h sessions) self-compassion intervention, either in the intervention group (n=11) or in a waitlist control group (n=8). The intervention was adapted from the standardized eight-session 'Making Friends with Yourself' programme, and sessions were delivered 1 week apart. Acceptability was assessed through qualitative questionnaires and feasibility was assessed based on session attendance and recruitment metrics. Possible changes to disordered eating behaviour, self-care behaviours, diabetes-related distress, self-compassion, stress and glycaemic control were also assessed. RESULTS Nineteen participants completed the study, and they reported an increased sense of common humanity (acknowledging that we are not alone), mindfulness, and coping resources. In terms of feasibility, recruitment took longer than expected (8 months) and not all participants were able to attend both sessions (nine could only attend one of the two sessions). CONCLUSIONS While self-compassion is a strong conceptual fit for the issues of type 1 diabetes and disordered eating behaviour in adolescence, and the intervention content appears acceptable, feasibility issues were such that brief self-compassion programmes will probably need to be adapted into digital interventions for future research. (Trial registration number: ANZCTR 12619000541101).
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Affiliation(s)
- A L Boggiss
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - N S Consedine
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - K R Schache
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - C Jefferies
- Starship Children's Health, Auckland City Hospital, Auckland, New Zealand
| | - K Bluth
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - P L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - A S Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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19
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Ghio D, Greenwell K, Muller I, Roberts A, McNiven A, Santer M. Psychosocial needs of adolescents and young adults with eczema: A secondary analysis of qualitative data to inform a behaviour change intervention. Br J Health Psychol 2020; 26:214-231. [PMID: 32844574 DOI: 10.1111/bjhp.12467] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/22/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study aimed to explore adolescents and young adults' experiences of symptoms related to their eczema in order to determine their psychosocial needs. DESIGN A secondary qualitative analysis of two data sources collected through semi-structured interviews for two different projects, SKINS project and Eczema Care Online project. METHODS In total, there were 28 transcripts with adolescents and young adults with eczema having a mean age of 19.5 years available to analyse. Interview data were collected from face-to-face interviews that were recorded and transcribed. Inductive thematic analysis explored data about symptoms and organized according to psychosocial needs. RESULTS Adolescents and young adults with eczema experience both visible symptoms (such as flaky, dry, and inflamed skin) and invisible symptoms (such as itch, pain, exhaustion, and mental distress) that elicit different psychosocial needs. These psychosocial needs are to (i) be understood; (ii) be perceived as normal; and (iii) receive emotional support. Interviewees described a struggle between wanting their peers and family to understand but take their eczema seriously whilst not wanting to stand out and instead to be perceived as 'normal', which they would define as being perceived as other adolescents. This has implications on behaviours, such as seeking support, avoiding going out, hiding their skin, as well as emotional implications, such as social isolation and feeling anxious and low. CONCLUSIONS Having a better understanding of young people's experiences and psychosocial needs will provide a framework on how best to support adolescents and young adults when managing symptoms related to eczema. Statement of contribution What is already known on this subject? Eczema has a high impact on children and is considered a burden by children and adults with eczema. However, it is unclear what impact eczema has on adolescents and young adults. Adolescents and young adults with chronic conditions are known to be vulnerable to negative psychosocial outcomes but psychosocial needs and how to best support this age group with eczema are unknown What does this add? Three psychosocial needs were developed from evaluating the impact of visible and invisible symptoms of eczema: The need to feel understood (mostly reflective of invisible symptoms such as itch and pain and visible symptoms such as scratching). The need to be perceived as 'normal': visible symptoms such as flaky, inflamed skin make them stand out in comparison with their peers and a need emerged to blend in. The need for emotional support: adolescents and young adults searched for this from their health care providers, from shared experiences and from online resources. Adolescents and young adults with eczema appear to feel ambivalent about wishing the impact of the condition to be acknowledged whilst wishing the condition to be invisible to others. This ambivalence had further impact on feeling self-conscious, seeking support, and dealing with unsolicited advice.
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Affiliation(s)
- Daniela Ghio
- Primary Care and Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, UK
| | - Kate Greenwell
- Centre for Clinical and Community Applications of Health Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - Ingrid Muller
- Primary Care and Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, UK
| | - Amanda Roberts
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, UK
| | - Abigail McNiven
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Miriam Santer
- Primary Care and Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, UK
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20
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Bauer KW, Hilliard ME, Albright D, Lo SL, Fredericks EM, Miller AL. The Role of Parent Self-Regulation in Youth Type 1 Diabetes Management. Curr Diab Rep 2020; 20:37. [PMID: 32638126 PMCID: PMC8018188 DOI: 10.1007/s11892-020-01321-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Youth with strong self-regulation (SR), or the ability to manage thoughts, emotions, and behaviors, engage in more effective type 1 diabetes (T1D) management. However, while parent support and engagement are critical to ensuring positive youth T1D outcomes, it is rarely considered that parents' SR may also influence youth T1D management. If this is the case, novel interventions to improve parents' SR or ensure adequate support for parents with SR challenges offer great potential to improve family functioning and youth T1D management. RECENT FINDINGS Theoretical and preliminary empirical evidence suggests that parental SR impacts family processes that support youth T1D treatment regimen adherence. Furthermore, parent and youth SR likely interact, with high parent SR enhancing the positive effects of high youth SR or compensating for low youth SR. Continued research is needed to better understand the ways in which parent SR matters to youth T1D management and identify how to support improvements in T1D management among families of parents with low SR.
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Affiliation(s)
- Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, 3854 SPH I, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA.
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Dana Albright
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sharon L Lo
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Emily M Fredericks
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alison L Miller
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
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21
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Lee JL, Gutierrez-Colina A, Williamson Lewis R, Wasilewski-Masker K, Meacham LR, Mertens AC, Gilleland Marchak J. Knowledge of Late Effects Risks and Healthcare Responsibility in Adolescents and Young Adults Treated for Childhood Cancer. J Pediatr Psychol 2020; 44:557-566. [PMID: 30624691 DOI: 10.1093/jpepsy/jsy102] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/30/2018] [Accepted: 11/20/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE This study aimed to examine the level and predictors of knowledge of late effects risks from childhood cancer treatment in adolescent and young adult (AYA) survivors. METHODS Seventy-three AYAs, aged 14-21, completed measures of knowledge of late effect risks, executive functioning, and responsibility for health self-management. Sixty-seven parents of these AYA survivors (91.7%) also participated. RESULTS Survivors demonstrated poor knowledge of their unique risks for treatment-related late effects, with a mean accurate knowledge score of 54.29% (SD = 24.19%). The number of late effects for which survivors were at risk was negatively correlated with risk knowledge (r = -.34, p < .01). Survivors' executive functioning was not related to risk knowledge. In regression analyses, survivor age positively predicted accurate knowledge of late effects risks, and the number of late effects risk was a negative predictor. In separate models, survivor self-report of AYA responsibility for health self-management did not predict knowledge (R2 = .39, F = 10.86, p < .01), but parent proxy-report was a significant positive predictor (R2 = .38, F = 9.62, p < .01). Parental involvement was not a significant predictor in either model. CONCLUSION There are significant knowledge gaps among AYA survivors of childhood cancer, which appear to be related to younger AYA age and lower levels of AYA responsibility for health self-management. Additional intervention is critical to increase AYA knowledge of their risk for late effects in order to promote continued engagement in long-term follow-up care and surveillance across the lifespan.
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Affiliation(s)
- Jennifer L Lee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta.,Department of Pediatrics, Emory University School of Medicine
| | | | | | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta.,Department of Pediatrics, Emory University School of Medicine
| | - Lillian R Meacham
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta.,Department of Pediatrics, Emory University School of Medicine
| | - Ann C Mertens
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta.,Department of Pediatrics, Emory University School of Medicine
| | - Jordan Gilleland Marchak
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta.,Department of Pediatrics, Emory University School of Medicine
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22
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Crochiere RJ, Hughes Lansing A, Carracher A, Vaid E, Stanger C. Attentional bias to diabetes cues mediates disease management improvements in a pilot randomized controlled trial for adolescents with type 1 diabetes. J Health Psychol 2020; 26:2699-2710. [PMID: 32508201 DOI: 10.1177/1359105320926535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
For type 1 diabetes management, the role of attentional bias remains unclear. This secondary analysis examined type 1 diabetes attentional bias and adolescent type 1 diabetes management prior to and during a cognitive and behavioral intervention. Youth with type 1 diabetes and above target glycemic control were assigned to intervention or usual care control. Participants completed baseline and follow-up type 1 diabetes Stroop tasks, HbA1c tests, and blood glucose meter downloads. Intervention was associated with greater reductions in type 1 diabetes attentional bias than control, and these reductions partially mediated the effect of treatment on diabetes management behaviors. Type 1 diabetes attentional bias is a potential target to improve type 1 diabetes management.
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23
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Eaton CK, Duraccio KM, Eakin MN, Brady TM, Pruette CS, Eckmann T, Mendley SR, Tuchman S, Fivush BA, Riekert KA. Executive functioning, caregiver monitoring, and medication adherence over time in adolescents with chronic kidney disease. Health Psychol 2020; 39:509-518. [PMID: 32202823 PMCID: PMC8344353 DOI: 10.1037/hea0000851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate associations between executive functioning and caregiver adherence monitoring with objective antihypertensive medication adherence over 24 months in adolescents with chronic kidney disease (CKD). METHODS Adolescents (N = 97, 11-20 years old) with CKD taking antihypertensive medication and their caregivers were recruited from three pediatric nephrology clinics. At baseline, adolescents and caregivers reported on adolescents' executive functioning and caregivers reported on their adherence monitoring. Antihypertensive medication adherence was objectively assessed via electronic monitoring at baseline and every 6 months after for 24 months. Associations between executive functioning, caregiver monitoring, and longitudinal adherence were evaluated with linear mixed models. RESULTS Up to 38% of adolescents had elevated executive functioning scores indicating more severe impairments, with rates varying by scale and reporter (adolescent vs. caregiver). Caregiver monitoring showed a significant, negative association with adherence, but adolescents' executive functioning was not significantly associated with adherence. Neither variable was associated with the rate of change in adherence over time. CONCLUSIONS Given that adolescents' executive functioning was not associated with antihypertensive medication adherence or changes in adherence over time, adherence to daily pill-form medications may involve less cognitive effort than more complex medical regimens. Higher levels of caregiver monitoring were unexpectedly associated with lower adherence levels. This unanticipated finding may reflect increased caregiver monitoring efforts when faced with adolescents' medication nonadherence, but this finding warrants further investigation. Adolescents with CKD who are nonadherent may benefit from medication adherence-promoting strategies beyond increasing caregiver monitoring. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | - Susan R. Mendley
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
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24
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Fedele DA, Cushing CC, Koskela-Staples N, Patton SR, McQuaid EL, Smyth JM, Prabhakaran S, Gierer S, Nezu AM. Adaptive Mobile Health Intervention for Adolescents with Asthma: Iterative User-Centered Development. JMIR Mhealth Uhealth 2020; 8:e18400. [PMID: 32374273 PMCID: PMC7240449 DOI: 10.2196/18400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/27/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adolescents diagnosed with persistent asthma commonly take less than 50% of their prescribed inhaled corticosteroids (ICS), placing them at risk for asthma-related morbidity. Adolescents' difficulties with adherence occur in the context of normative developmental changes (eg, increased responsibility for disease management) and rely upon still developing self-regulation and problem-solving skills that are integral for asthma self-management. We developed an adaptive mobile health system, Responsive Asthma Care for Teens (ReACT), that facilitates self-regulation and problem-solving skills during times when adolescents' objectively measured ICS adherence data indicate suboptimal rates of medication use. OBJECTIVE The current paper describes our user-centered and evidence-based design process in developing ReACT. We explain how we leveraged a combination of individual interviews, national crowdsourced feedback, and an advisory board comprised of target users to develop the intervention content. METHODS We developed ReACT over a 15-month period using one-on-one interviews with target ReACT users (n=20), national crowdsourcing (n=257), and an advisory board (n=4) to refine content. Participants included 13-17-year-olds with asthma and their caregivers. A total of 280 adolescents and their caregivers participated in at least one stage of ReACT development. RESULTS Consistent with self-regulation theory, adolescents identified a variety of salient intrapersonal (eg, forgetfulness, mood) and external (eg, changes in routine) barriers to ICS use during individual interviews. Adolescents viewed the majority of ReACT intervention content (514/555 messages, 93%) favorably during the crowdsourcing phase, and the advisory board helped to refine the content that did not receive favorable feedback during crowdsourcing. Additionally, the advisory board provided suggestions for improving additional components of ReACT (eg, videos, message flow). CONCLUSIONS ReACT involved stakeholders via qualitative approaches and crowdsourcing throughout the creation and refinement of intervention content. The feedback we received from participants largely supported ReACT's emphasis on providing adaptive and personalized intervention content to facilitate self-regulation and problem-solving skills, and the research team successfully completed the recommended refinements to the intervention content during the iterative development process.
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Affiliation(s)
- David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, United States
| | - Christopher C Cushing
- Clinical Child Psychology Program & Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS, United States
| | - Natalie Koskela-Staples
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, United States
| | - Susana R Patton
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Jacksonville, FL, United States
| | - Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States
| | - Joshua M Smyth
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, United States
| | | | - Selina Gierer
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, MO, United States
| | - Arthur M Nezu
- Department of Psychology, Drexel University, Philadelphia, PA, United States
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25
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Schuiteman S, Chua KP, Plegue MA, Ilyas O, Chang T. Self-Management of Health Care Among Youth: Implications for Policies on Transitions of Care. J Adolesc Health 2020; 66:616-622. [PMID: 32113903 PMCID: PMC7980769 DOI: 10.1016/j.jadohealth.2020.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/01/2020] [Accepted: 01/03/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE Transitions from pediatric to adult health care are important milestones for youth. In surveys, providers report that youth lack the motivation or skills to manage their care independently, a prerequisite for successful transitions. To assess the validity of this belief, we surveyed youth regarding their current and desired level of involvement in their care. METHODS In 2017-2018, we conducted a national text message survey of youth aged 14-24 years. The survey included three open-ended questions assessing participants' independence on three health care tasks (scheduling appointments, attending appointments, and picking up prescriptions) and one open-ended question assessing their desire to be more, less, or equally involved in their care as they are now. We qualitatively analyzed free-text responses to identify themes. RESULTS Among 1,214 eligible participants, 805 (66.3%) completed all four questions and were included in the sample. Forty-one percent of youth reported wanting to be more involved in their care. Among young adults aged 18-24 years, 22% were not fully independent on the three health care tasks and reported wanting to be less involved or equally as involved as they are currently. CONCLUSION Many youth should be viewed as partners in health care transitions instead of as barriers, but some youth are at high risk for failed transitions. Policymakers and providers should promote routine screening of youth for their current levels of engagement in care and desire to be more involved.
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Affiliation(s)
- Sam Schuiteman
- University of Michigan Medical School, Ann Arbor, Michigan.
| | - Kao-Ping Chua
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan; Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Omar Ilyas
- University of Michigan, Ann Arbor, Michigan
| | - Tammy Chang
- Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
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26
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Al Hayek AA, Robert AA, Al Dawish MA. Effectiveness of the Freestyle Libre Flash Glucose Monitoring System on Diabetes Distress Among Individuals with Type 1 Diabetes: A Prospective Study. Diabetes Ther 2020; 11:927-937. [PMID: 32146691 PMCID: PMC7136360 DOI: 10.1007/s13300-020-00793-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Indexed: 12/11/2022] Open
Abstract
AIM To study and explore the intervention of the flash glucose monitoring system (FGMS) on diabetes-related distress (DRD) in children and adolescents with type 1 diabetes (T1D). METHODS A 12-week prospective study was performed from March 2019 to July 2019 involving 187 children and adolescents (age range 13-19 years; 56.7% female) with T1D who were self-testing their glucose levels using the conventional fingerprick method. At the time of the baseline visit, FGMS sensors were fixed by a trained diabetes educator onto each patient in the study population. A trained interviewer also administered the 28-item T1-Diabetes Distress Scale (T1-DDS) questionnaire to each participant at the baseline visit and again after 12 weeks to determine the T1-DDS score. RESULTS Comparison of the baseline (fingerprick) data with data collected at 12 weeks after the patients had switched to the FGMS revealed a significant decrease in the subdomains of the T1-DDS as follows: powerlessness (p = 0.0001); management distress (p = 0.0001); hypoglycemia distress (p = 0.0001); negative social perceptions (p = 0.0001); eating (p = 0.0001); physician distress (p = 0.0001); friend/family distress (p = 0.0001); and total T1-DDS score (p = 0.0001). Similarly, analysis of the data revealed that there was also a substantial drop from baseline to 12 weeks after initiation of the intervention in the clinical variables assessed, such as glycosylated hemoglobin; specifically, there was a considerable decrease after 12 weeks in the frequency of hypoglycemia. Interestingly, the frequency of glucose monitoring also showed an upswing among users of the FGMS. CONCLUSION The outcomes of this study clearly demonstrate that once the patients had been switched from the fingerprick method to FGMS, the DRD and related clinical parameters showed remarkable improvement. However, further studies are necessary to determine whether the continued and consistent use of the FGMS will achieve better results.
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Affiliation(s)
- Ayman A Al Hayek
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Asirvatham A Robert
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed A Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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27
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Miller AL, Lo SL, Albright D, Lee JM, Hunter CM, Bauer KW, King R, Clark KM, Chaudhry K, Kaciroti N, Katz B, Fredericks EM. Adolescent Interventions to Manage Self-Regulation in Type 1 Diabetes (AIMS-T1D): randomized control trial study protocol. BMC Pediatr 2020; 20:112. [PMID: 32145739 PMCID: PMC7060523 DOI: 10.1186/s12887-020-2012-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-regulation (SR), or the capacity to control one's thoughts, emotions, and behaviors in order to achieve a desired goal, shapes health outcomes through many pathways, including supporting adherence to medical treatment regimens. Type 1 Diabetes (T1D) is one specific condition that requires SR to ensure adherence to daily treatment regimens that can be arduous and effortful (e.g., monitoring blood glucose). Adolescents, in particular, have poor adherence to T1D treatment regimens, yet it is essential that they assume increased responsibility for managing their T1D as they approach young adulthood. Adolescence is also a time of rapid changes in SR capacity and thus a compelling period for intervention. Promoting SR among adolescents with T1D may thus be a novel method to improve treatment regimen adherence. The current study tests a behavioral intervention to enhance SR among adolescents with T1D. SR and T1D medical regimen adherence will be examined as primary and secondary outcomes, respectively. METHODS We will use a randomized control trial design to test the impact of a behavioral intervention on three SR targets: Executive Functioning (EF), Emotion Regulation (ER), and Future Orientation (FO); and T1D medical regimen adherence. Adolescents with T1D (n = 94) will be recruited from pediatric endocrinology clinics and randomly assigned to treatment or control group. The behavioral intervention consists of working memory training (to enhance EF), biofeedback and relaxation training (to enhance ER), and episodic future thinking training (to enhance FO) across an 8-week period. SR and treatment regimen adherence will be assessed at pre- and post-test using multiple methods (behavioral tasks, diabetes device downloads, self- and parent-report). We will use an intent-to-treat framework using generalized linear mixed models to test our hypotheses that: 1) the treatment group will demonstrate greater improvements in SR than the control group, and 2) the treatment group will demonstrate better treatment regimen adherence outcomes than the control group. DISCUSSION If successful, SR-focused behavioral interventions could improve health outcomes among adolescents with T1D and have transdiagnostic implications across multiple chronic conditions requiring treatment regimen adherence. TRIAL REGISTRATION ClinicalTrials.gov: NCT03688919; registered September 28, 2018.
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Affiliation(s)
- Alison L Miller
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH I Room 3718, Ann Arbor, MI, 48109-2029, USA.
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA.
| | - Sharon L Lo
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH I Room 3718, Ann Arbor, MI, 48109-2029, USA
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Dana Albright
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Joyce M Lee
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, USA
| | - Katherine W Bauer
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Rosalind King
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Katy M Clark
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH I Room 3718, Ann Arbor, MI, 48109-2029, USA
| | - Kiren Chaudhry
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH I Room 3718, Ann Arbor, MI, 48109-2029, USA
| | - Niko Kaciroti
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Benjamin Katz
- Department of Human Development and Family Science, Virginia Tech, Blacksburg, VA, USA
| | - Emily M Fredericks
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
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28
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Miller AL, Lo SL, Bauer KW, Fredericks EM. Developmentally informed behaviour change techniques to enhance self-regulation in a health promotion context: a conceptual review. Health Psychol Rev 2020; 14:116-131. [PMID: 31957556 PMCID: PMC7254982 DOI: 10.1080/17437199.2020.1718530] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
Self-regulation (SR), or the ability to manage thoughts, emotions, and behaviours in order to achieve a desired goal, is seen as underlying positive health behaviours. In adults, behaviour change techniques (BCTs) are recommended to promote SR across health domains; although establishing healthy habits early in life is important, studies of SR and health in children are rare. This conceptual review provides guidance on developmental considerations for applying BCTs to enhance SR capacity in children and youth with the goal of fostering positive behavioural health trajectories early in the lifespan. Key considerations include the nature of developmental changes in SR and interaction among SR processes; temporal associations between SR and health behaviours; and relevance of health goals for children and youth. Building on a meta-review of BCT's used to promote SR in adults and youth, this conceptual review highlights key SR milestones to consider in behaviour change-focused interventions from early childhood through adolescence and provides an overview of social-ecologic influences on SR development and associations between SR and health behaviours across these age periods. Implications for and examples of using developmentally-informed BCTs in interventions to enhance SR in children and youth are noted and suggestions for future research are discussed.
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Affiliation(s)
- Alison L Miller
- Department of Health Behaviour and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sharon L Lo
- Department of Health Behaviour and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Katherine W Bauer
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Emily M Fredericks
- Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor, MI, USA
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29
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Finlay-Jones A, Boyes M, Perry Y, Sirois F, Lee R, Rees C. Online self-compassion training to improve the wellbeing of youth with chronic medical conditions: protocol for a randomised control trial. BMC Public Health 2020; 20:106. [PMID: 31992269 PMCID: PMC6986046 DOI: 10.1186/s12889-020-8226-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/15/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chronic medical conditions (CMCs) affect up to 35% of children and adolescents. Youth with chronic medical conditions are at an increased risk of psychological distress and reduced health-related quality of life, and report rates of mental illness up to double that of their physically healthy peers. Accessible, evidence-based interventions for young people with chronic illness are urgently required to improve their mental health and daily functioning. Self-compassion involves taking a mindful, accepting approach to difficult experiences, being aware that one is not alone in one's suffering, and being kind and understanding with oneself during challenging times. Self-compassion shares strong associations with mental health outcomes among young people and preliminary work indicates that interventions that build self-compassion have the potential to substantially improve youth mental health. Self-compassion is also associated with better physical and mental health outcomes among individuals living with CMCs. While face-to-face self-compassion training is available, there are several barriers to access for youth with CMCs. Online self-compassion training potentially offers an accessible alternative for this high-risk group. METHODS Self-Compassion Online (SCO) is a self-compassion program that has been tested with a non-clinical adult group. For the proposed trial, a reference group of youth (16-25 years) with chronic illness reviewed the program and proposed adaptations to improve its suitability for youth with chronic illness. In alignment with the SPIRIT Checklist, this paper outlines the protocol for a CONSORT-compliant, single-blind randomised controlled trial to test the efficacy of the adapted program, relative to a waitlist control, for improving self-compassion, wellbeing, distress, emotion regulation, coping and quality of life among young Australians with CMCs. Mechanisms of action and feasibility of SCO will be analysed using quantitative data and participant interviews, respectively. Finally, cost-utility will be analysed using health-related quality of life data. DISCUSSION The SCO program could provide a scalable solution for improving psychological outcomes and quality of life among youth with chronic illness. The proposed trial will be the first to determine its efficacy for improving these outcomes, relative to waitlist control. TRIAL REGISTRATION The trial was registered on the Australian New Zealand Clinical Trials Registry on the 11th April 2019, ACTRN12619000572167. Protocol version: Version 2, 21 December 2019.
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Affiliation(s)
- Amy Finlay-Jones
- Telethon Kids Institute, PO Box 855, West Perth, Western Australia, 6872, Australia. .,School of Psychology, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia. .,University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Mark Boyes
- School of Psychology, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Yael Perry
- Telethon Kids Institute, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - Fuschia Sirois
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield, S1 2LT, UK
| | - Rachael Lee
- School of Psychology, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Clare Rees
- School of Psychology, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
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Silva K, Miller VA. Parenting and the Development of Impulse Control in Youth with Type 1 Diabetes: The Mediating Role of Negative Affect. APPLIED DEVELOPMENTAL SCIENCE 2019; 26:94-108. [PMID: 35702178 PMCID: PMC9191768 DOI: 10.1080/10888691.2019.1700797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Parents are important for the development and maintenance of regulatory control. The current longitudinal study examined associations between parental coercion and autonomy support and impulse control in 117 youth (ages 8-16; Mage= 12.87, SD=2.53; 44% male) with Type 1 diabetes and explored whether youth negative affect mediated these associations. Parental coercion (but not autonomy support) was concurrently associated with lower impulse control and higher negative affect within individuals. Increases in youth negative affect partially mediated the within-person association between parental coercion and impulse control. These findings suggest that parent-directed interventions to reduce parental coercion may be most beneficial for impulse control if combined with youth-directed interventions to help them regulate negative affect. Replication of the current findings in a larger sample of youth with and without a chronic illness is needed to address the theoretical and empirical importance of negative affect as a potential mechanism through which parental coercion impacts youth impulsivity.
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Affiliation(s)
- Karol Silva
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Victoria A Miller
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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31
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Gowey MA, Lim CS, Dutton GR, Silverstein JH, Dumont-Driscoll MC, Janicke DM. Executive Function and Dysregulated Eating Behaviors in Pediatric Obesity. J Pediatr Psychol 2019; 43:834-845. [PMID: 28595362 PMCID: PMC6093324 DOI: 10.1093/jpepsy/jsx091] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/23/2017] [Indexed: 01/12/2023] Open
Abstract
Objective To examine the association between caregiver proxy report of executive function (EF) and dysregulated eating behavior in children with obesity. Methods Participants were 195 youth with obesity aged 8-17 years, and their legal guardians. Youth height, weight, demographics, depressive symptoms, eating behaviors, and EF were assessed cross-sectionally during a medical visit. Analyses of covariance, adjusted for child age, gender, race/ethnicity, standardized BMI, depressive symptoms, and family income were used to examine differences in youth EF across caregiver and youth self-report of eating behaviors. Results Youth EF differed significantly by caregiver report of eating behavior but not youth self-report. Post hoc analyses showed that youth with overeating or binge eating had poorer EF than youth without these eating behaviors. Conclusions Executive dysfunction, as reported by caregivers, in youth with obesity may be associated with dysregulated eating behaviors predictive of poor long-term psychosocial and weight outcomes. Further consideration of EF-specific targets for assessment and intervention in youth with obesity may be warranted.
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Affiliation(s)
- Marissa A Gowey
- Division of Preventive Medicine, University of Alabama at Birmingham
| | - Crystal S Lim
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | - Gareth R Dutton
- Division of Preventive Medicine, University of Alabama at Birmingham
| | | | | | - David M Janicke
- Department of Clinical and Health Psychology, University of Florida
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Crowley T, van der Merwe A, Skinner D. Adolescent HIV Self-management: Lived Experiences of Adolescents, Caregivers, and Health Care Workers in a South African Context. J Assoc Nurses AIDS Care 2019; 30:e7-e19. [PMID: 31241512 DOI: 10.1097/jnc.0000000000000098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Adolescence is a complex developmental phase, made more complex by chronic disease. When dealing with treatment and the health impact of chronic diseases, adolescents need to learn to self-manage an array of challenges. Unfortunately, there is a gap in the literature related to chronic disease self-management in adolescents living with HIV. We describe the phenomenon from the perspectives of adolescents, caregivers, and health care workers (HCWs) in South Africa. Individual interviews were conducted with 6 adolescents, 6 caregivers, and 6 HCWs, followed by 5 adolescent focus groups. Interpretive phenomenology guided exploration of social and cultural experiences and found that adolescent self-management required an understanding of HIV and hope for the future. Adolescents also needed skills to prioritize and negotiate care while managing stigma. These processes were facilitated by love and support, primarily from immediate family, and by the adolescent engaging with family, HCWs, and peers.
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Adverse Childhood Experiences and Chronic Medical Conditions: Emotion Dysregulation as a Mediator of Adjustment. J Clin Psychol Med Settings 2019; 27:572-581. [DOI: 10.1007/s10880-019-09639-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Sharkey CM, Perez MN, Bakula DM, Grant DM, Mullins LL. Exploratory Factor Analysis of the Mishel Uncertainty in Illness Scale Among Adolescents and Young Adults With Chronic Medical Conditions. J Pediatr Health Care 2019; 33:186-194. [PMID: 30177225 DOI: 10.1016/j.pedhc.2018.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/23/2018] [Accepted: 08/03/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To identify a developmentally relevant factor structure of the Mishel Uncertainty in Illness Scale-Community form (MUIS-C) among adolescents and young adults with chronic medical conditions. METHODS Data on college students with a self-reported chronic medical condition (N = 238) were collected between November 2013 and May 2015. Participants completed the MUIS-C as part of a larger questionnaire battery. An exploratory factor analysis and a confirmatory factor analysis were conducted. RESULTS The exploratory factor analysis resulted in a 22-item model with two factors termed: (a) Ambiguity/Future Uncertainty (α = .93), and (b) Unpredictability (α = .89). The confirmatory factor analysis and a correlated uniquenesses model, which evaluated method effects, supported the two-factor model. DISCUSSION These findings highlight the unique nature of illness uncertainty among adolescents and young adults and show the clinical and research utility of the MUIS-C for this population. Future investigations should examine how the two factors relate to distress among adolescents and young adults.
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Lansing AH, Guthrie KM, Hadley W, Stewart A, Peters A, Houck CD. Qualitative Assessment of Emotion Regulation Strategies for Prevention of Health Risk Behaviors in Early Adolescents. JOURNAL OF CHILD AND FAMILY STUDIES 2019; 28:765-775. [PMID: 31680761 PMCID: PMC6824428 DOI: 10.1007/s10826-018-01305-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The ability to regulate emotions has been linked to a variety of adolescent health risk behaviors, including sexual risk behaviors, especially for adolescents who are experiencing mental health symptoms. However, there is limited information available on intuitive emotion regulation strategies for early adolescents with mental health symptoms to facilitate the adaptation of emotion regulation interventions for psychopathology to health risk behavior prevention. For example, interventions to prevent sexual risk behaviors in early adolescence have yet to specifically target emotion regulation. This paper describes the use of focus groups to identify emotion regulation strategies that were understood by and acceptable to early adolescents with mental health symptoms who are also more likely to engage in risky health behaviors. Qualitative data were collected through focus groups (k=5 groups) with 15 early adolescents with mental health symptoms. The most commonly generated emotion regulation strategies were leaving the situation, distraction, physical release, expressing oneself to someone, positive thinking, and considering other options. Translation of these findings for use in preventive health-risk behavior interventions (including for sexual risk) is discussed.
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Affiliation(s)
- Amy Hughes Lansing
- Bradley/Hasbro Children's Research Center, & Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Kate M Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University & The Miriam Hospital, Providence, RI, USA
| | - Wendy Hadley
- Bradley/Hasbro Children's Research Center, & Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | | | - April Peters
- Bradley/Hasbro Children's Research Center, Providence, RI, USA
| | - Christopher D Houck
- Bradley/Hasbro Children's Research Center, & Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Lansing AH, Stoianova M, Stanger C. Adolescent Emotional Control Moderates Benefits of a Multicomponent Intervention to Improve Type 1 Diabetes Adherence: A Pilot Randomized Controlled Trial. J Pediatr Psychol 2019; 44:126-136. [PMID: 30247640 PMCID: PMC6319445 DOI: 10.1093/jpepsy/jsy071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 11/13/2022] Open
Abstract
Objective We previously tested via randomized controlled trial a novel intervention for adolescents with type 1 diabetes and above-target glycemic control that combined web-delivered incentives for self-monitoring of blood glucose (SMBG) and brief web counseling with working memory training and parental contingency contracting training. Results showed improved SMBG and decreased glycosylated hemoglobin (HbA1c) at 6- and 12-month follow-ups. However, it has not been elucidated if improvements in SMBG mediated the immediate benefits of this treatment on HbA1c nor if this intensive intervention uniquely benefited a subgroup of adolescents with higher problems in emotional control. Methods Adolescents with type 1 diabetes and above-target glycemic control (n = 61) were randomized to receive the 6-month intervention (n = 30) or usual care (n = 31). Adolescents completed the Behavior Rating Inventory of Executive Function-Self-Report, problems with emotional control subscale at baseline, and provided meter downloads to assess frequency of SMBG and completed an HbA1c blood draw at baseline and 6 months later. Results At 6-month follow-up, improvements in SMBG mediated the effects of receiving the treatment on having lower average HbA1c. Further, problems in emotional control moderated the benefits of the intervention on improvements in SMBG and in turn HbA1c. Only adolescents with above average problems in emotional control evidenced improvements in SMBG in response to treatment, which then explained lower HbA1c levels at 6-month follow-up. Conclusions This multicomponent, web-delivered intervention provided unique benefits for improving SMBG and lowering HbA1c in teens with higher problems in emotional control.
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Affiliation(s)
| | - Maria Stoianova
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth
| | - Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth
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Fisher L, Hessler D, Polonsky WH, Masharani U, Guzman S, Bowyer V, Strycker L, Ahmann A, Basina M, Blumer I, Chloe C, Kim S, Peters AL, Shumway M, Weihs K, Wu P. T1-REDEEM: A Randomized Controlled Trial to Reduce Diabetes Distress Among Adults With Type 1 Diabetes. Diabetes Care 2018; 41:1862-1869. [PMID: 29976567 PMCID: PMC6105321 DOI: 10.2337/dc18-0391] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 06/09/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the effectiveness of two interventions to reduce diabetes distress (DD) and improve glycemic control among adults with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS Individuals with T1D (n = 301) with elevated DD and HbA1c were recruited from multiple settings and randomly assigned to OnTrack, an emotion-focused intervention, or to KnowIt, an educational/behavioral intervention. Each group attended a full-day workshop plus four online meetings over 3 months. Assessments occurred at baseline and 3 and 9 months. Primary and secondary outcomes were change in DD and change in HbA1c, respectively. RESULTS With 12% attrition, both groups demonstrated dramatic reductions in DD (effect size d = 1.06; 78.4% demonstrated a reduction of at least one minimal clinically important difference). There were, however, no significant differences in DD reduction between OnTrack and KnowIt. Moderator analyses indicated that OnTrack provided greater DD reduction to those with initially poorer cognitive or emotion regulation skills, higher baseline DD, or greater initial diabetes knowledge than those in KnowIt. Significant but modest reductions in HbA1c occurred with no between-group differences. Change in DD was modestly associated with change in HbA1c (r = 0.14, P = 0.01), with no significant between-group differences. CONCLUSIONS DD can be successfully reduced among distressed individuals with T1D with elevated HbA1c using both education/behavioral and emotion-focused approaches. Reductions in DD are only modestly associated with reductions in HbA1c. These findings point to the importance of tailoring interventions to address affective, knowledge, and cognitive skills when intervening to reduce DD and improve glycemic control.
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Affiliation(s)
| | | | | | | | | | - Vicky Bowyer
- University of California, San Francisco, San Francisco, CA
| | | | | | | | | | - Charles Chloe
- Veterans Affairs San Diego Healthcare System, University of California, San Diego, San Diego, CA
| | - Sarah Kim
- University of California, San Francisco, San Francisco, CA
| | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Martha Shumway
- University of California, San Francisco, San Francisco, CA
| | - Karen Weihs
- University of Arizona College of Medicine, Tucson, AZ
| | - Patricia Wu
- Kaiser Permanente Medical Group, San Diego, CA
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Devine KA, Monaghan M, Schwartz LA. Introduction to the Special Issue on Adolescent and Young Adult Health: Why We Care, How Far We Have Come, and Where We Are Going. J Pediatr Psychol 2018; 42:903-909. [PMID: 29046043 DOI: 10.1093/jpepsy/jsx101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/24/2017] [Indexed: 11/14/2022] Open
Abstract
This special issue on adolescent and young adult (AYA) health comprises 15 original articles. The special issue recognizes the importance of AYA-focused research, highlights unique issues across the AYA period, and showcases cutting-edge research focused on AYAs. We describe the rationale for focusing on the AYA population, themes of the special issue, and future directions.
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Affiliation(s)
- Katie A Devine
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey
| | - Maureen Monaghan
- Department of Psychology & Behavioral Health, Children's National Health System
| | - Lisa A Schwartz
- The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania
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Wiebe DJ, Berg CA, Mello D, Kelly CS. Self- and Social-Regulation in Type 1 Diabetes Management During Late Adolescence and Emerging Adulthood. Curr Diab Rep 2018; 18:23. [PMID: 29564640 DOI: 10.1007/s11892-018-0995-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW This paper aims to examine how self-regulation (i.e., cognition, emotion) and social-regulation (i.e., parents, friends, romantic partners) are interrelated risk and protective factors for type 1 diabetes management during late adolescence and emerging adulthood. RECENT FINDINGS Problems in cognitive (e.g., executive function) and emotional (e.g., depressive symptoms) self-regulation are associated with poorer management, both at the between- and within-person levels. Better management occurs when parents are supportive and when individuals actively regulate the involvement of others (e.g., seek help, minimize interference). Friends both help and hinder self-regulation, while research on romantic partners is limited. Facets of self- and social-regulation are important risk and protective factors for diabetes management during emerging adulthood. At this time when relationships are changing, the social context of diabetes may need to be regulated to support diabetes management. Interventions targeting those with self-regulation problems and facilitating self- and social-regulation in daily life may be useful.
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Affiliation(s)
- Deborah J Wiebe
- Psychological Sciences and the Health Sciences Research Institute, University of California, Merced, 5200 N. Lake Road, Merced, CA, 95343, USA.
| | - Cynthia A Berg
- Department of Psychology, University of Utah, 380 South 1530 East, Salt Lake City, UT, 84112, USA
| | - Daniel Mello
- Psychological Sciences and the Health Sciences Research Institute, University of California, Merced, 5200 N. Lake Road, Merced, CA, 95343, USA
| | - Caitlin S Kelly
- Department of Psychology, University of Utah, 380 South 1530 East, Salt Lake City, UT, 84112, USA
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Butner JE, Berg CA, Munion AK, Turner SL, Hughes-Lansing A, Winnick JB, Wiebe DJ. Coordination of Self- and Parental-Regulation Surrounding Type I Diabetes Management in Late Adolescence. Ann Behav Med 2018; 52:29-41. [PMID: 28585097 PMCID: PMC5716913 DOI: 10.1007/s12160-017-9922-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background Type 1 diabetes management involves self- and social-regulation, with past research examining components through individual differences unable to capture daily processes. Purpose Dynamical systems modeling was used to examine the coordinative structure of self- and social-regulation (operationalized as parental-regulation) related to daily diabetes management during late adolescence. Methods Two hundred and thirty-six late adolescents with type 1 diabetes (M age = 17.77 years, SD = .39) completed a 14-day diary reporting aspects of self- (e.g., adherence behaviors, cognitive self-regulation failures, and positive and negative affect) and parental-regulation (disclosure to parents, knowledge parents have, and help parents provide). Results Self-regulation functioned as one coordinative structure that was separate from parental-regulation, where mothers and fathers were coordinated separately from each other. Mothers' perceived helpfulness served as a driver of returning adolescents back to homeostasis. Conclusions The results illustrate a dynamic process whereby numerous facets of self- and social-regulation are coordinated in order to return diabetes management to a stable state.
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Affiliation(s)
- Jonathan E Butner
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - A K Munion
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Sara L Turner
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | | | - Joel B Winnick
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Deborah J Wiebe
- Department of Psychology, University of California at Merced, Merced, CA, USA
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Fisher L, Hessler D, Polonsky W, Strycker L, Guzman S, Bowyer V, Blumer I, Masharani U. Emotion regulation contributes to the development of diabetes distress among adults with type 1 diabetes. PATIENT EDUCATION AND COUNSELING 2018; 101:124-131. [PMID: 28739179 PMCID: PMC5732076 DOI: 10.1016/j.pec.2017.06.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/15/2017] [Accepted: 06/26/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To demonstrate how maladaptive emotion regulation (ER) can lead to diabetes distress (DD), with subsequent effects on management and metabolic outcomes among adults with type 1 diabetes. METHODS Data are based on pre-intervention assessment for a random controlled trial to reduce DD. Patients were recruited in California, Oregon, Arizona and Ontario, Canada. After screening and consent, patients completed an online assessment and released their most recent laboratory HbA1C. Structural equation modeling was used to define an ER measurement model and test for significant pathways. RESULTS Three ER mechanisms combined into a single construct: emotion processing, non-judgment of emotions, non-reactivity to emotions. Models indicated a significant pathway from ER and cognitions to DD to disease management to metabolic control. CONCLUSIONS As hypothesized, the three ER mechanisms formed a single, coherent ER construct. Patients with poor ER reported high DD; and high DD was linked to poor diabetes management and poor metabolic control. PRACTICE IMPLICATIONS Identifying both the level of DD and the ER mechanisms that lead to high DD should be explored in clinical settings. Helping T1Ds to become more aware, less judgmental and less reactive behaviorally to what they feel about diabetes and its management may reduce DD.
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Affiliation(s)
- Lawrence Fisher
- Department of Family & Community Medicine, UCSF, San Francisco, CA, USA.
| | - Danielle Hessler
- Department of Family & Community Medicine, UCSF, San Francisco, CA, USA.
| | - William Polonsky
- Behavioral Diabetes Institute, Department of Psychiatry, UCSD, San Diego, CA, USA.
| | | | - Susan Guzman
- Behavioral Diabetes Institute, San Diego, CA, USA.
| | - Vicky Bowyer
- Department of Family & Community Medicine, UCSF, San Francisco, CA, USA.
| | - Ian Blumer
- Charles H. Best Diabetes Centre, Ontario, Canada.
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The relationship between self-esteem, sense of self-efficacy and level of illness acceptance, and healthful behaviours in patients with long-term illnesses (type II diabetes, Hashimoto’s disease). HEALTH PSYCHOLOGY REPORT 2017. [DOI: 10.5114/hpr.2018.71635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BackgroundHashimoto thyroiditis and type II diabetes are chronic diseases which have adverse consequences impacting emotional and cognitive functioning. Healthful behaviours focused on improvement of one’s health or on combating the illness play a key role in psychosocial functioning of a person, particularly one suffering from a long-term illness. The aim of the research was the measurement and analysis of healthful behaviours and the distinction of variables determining healthful behaviours. We attempted to examine the connection between adhering to healthful behaviours, and the level of illness acceptance, self-efficacy and self-esteem, in terms of exhibiting healthful behaviours in the above-mentioned groups of patients.Participants and procedureThe study group consisted of 140 persons (70 persons with type II diabetes, 70 persons with Hashimoto’s disease). The following measurement techniques were used: the Health Behaviour Inventory by Z. Juczyński, the General Self-Efficacy Scale by R. Schwarzer and M. Jerusalem adapted for Polish by Z. Juczyński, the Acceptance of Illness Scale by B. J. Felton, T. A. Revenson and G. A. Hinrichsen, and the Self-Esteem Scale by M. Rosenberg.ResultsThe results show that for the group of type II diabetes patients self-efficacy constitutes a statistically significant moderate positive predictor of psychological attitude and appropriate eating habits, and is a positive weak predictor of general healthful behaviour and prophylaxis at the tendency level. For Hashimoto’s sufferers the sense of self-efficacy is a statistically significant moderate predictor of healthful behaviours.ConclusionsThe study investigated significant relations between the level of illness acceptance, the sense of self-efficacy and self-esteem, and engagement in healthful behaviour. The sense of self-efficacy determines higher healthful practices in both research groups. The study allowed for a comparison of two groups of long-term illnesses sufferers – type II diabetes, and Hashimoto’s disease – in terms of adhering to healthful behaviours, and dependencies between selected psychological variables and patients’ preferred healthful behaviours.
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Berg CA, Butner J, Wiebe DJ, Lansing AH, Osborn P, King PS, Palmer DL, Butler JM. Developmental model of parent-child coordination for self-regulation across childhood and into emerging adulthood: Type 1 diabetes management as an example. DEVELOPMENTAL REVIEW 2017; 46:1-26. [DOI: 10.1016/j.dr.2017.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Rapp AM, Chavira DA, Sugar CA, Asarnow JR. Integrated Primary Medical-Behavioral Health Care for Adolescent and Young Adult Depression: Predictors of Service Use in the Youth Partners in Care Trial. J Pediatr Psychol 2017; 42:1051-1064. [PMID: 28369443 PMCID: PMC5896616 DOI: 10.1093/jpepsy/jsx057] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/01/2017] [Accepted: 02/08/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives Depression, a chronic and disabling condition, frequently has its first onset during adolescence, underscoring the value of early effective treatment and prevention. Integrated medical-behavioral health care provides one strategy for improving treatment access for adolescents and young adults (AYA). Methods This study examined predictors of accessing treatment in a multisite randomized controlled trial evaluating an integrated collaborative care intervention aimed at improving access to evidence-based depression treatment through primary health care, compared with usual care. Results The integrated care intervention was able to overcome barriers to care associated with an initial reluctance to pursue active treatment and older age. Service use was low in both conditions among less acculturated/non-English-speaking families. Conclusions Results support the value of integrated medical-behavioral health care for improving rates of care. Findings highlight mechanisms by which integrated care may lead to improved rates of care and outcomes for AYA, an underserved and understudied group.
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Affiliation(s)
- Amy M. Rapp
- Department of Psychology, University of California
| | | | - Catherine A. Sugar
- Department of Biostatistics, Los Angeles School of Public Health, University of California
- Department of Psychiatry and Biobehavioral Sciences, Los Angeles Semel Institute for Neuroscience and Human Behavior, University of California
| | - Joan R. Asarnow
- Department of Psychiatry and Biobehavioral Sciences, Los Angeles Semel Institute for Neuroscience and Human Behavior, University of California
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Abstract
OBJECTIVE To determine feasibility of using the interactive Mobile Health and Rehabilitation (iMHere) system in spina bifida and its effects on psychosocial and medical outcomes. DESIGN In a randomized controlled trial, 13 intervention participants using the iMHere system and receiving usual care and 10 control participants receiving usual care were followed for 1 year. RESULTS Feasibility of use of the system was demonstrated by participants using a customized smartphone system for reminders to conduct various self-care tasks, upload photos of wounds, manage medications, complete mood surveys, and for secure messaging. High usage of the system was associated with positive changes in the subscales of the Adolescent Self-Management and Independence Scale II. CONCLUSION Use of the iMHere system in spina bifida is feasible and was associated with short-term self-reported improvements in self-management skill. This system holds promise for use in many diverse chronic care models to support and increase self-management skills.
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Lansing AH, Crochiere R, Cueto C, Wiebe DJ, Berg CA. Mother, father, and adolescent self-control and adherence in adolescents with Type 1 diabetes. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2017; 31:495-503. [PMID: 28080079 PMCID: PMC5449231 DOI: 10.1037/fam0000292] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study explored whether shared self-control across a family system, including adolescent, mother, and father self-control, as well as the interaction of mother and father self-control, was associated with ease of completing adherence tasks and the completion of adherence behaviors related to the Type 1 diabetes (T1D) regimen. One hundred thirty-seven adolescents (M = 13.48 years), mothers, and fathers completed a self-report measure of self-control, while adolescents also self-reported on ease of completing adherence tasks and the frequency with which they completed adherence tasks. Higher adolescent, mother, father, and the interaction of mother and father self-control were each associated with greater adolescent perceptions of ease of completing adherence tasks. Also, greater adolescent perception of ease of adherence mediated the association of higher adolescent, father, and the interaction of mother and father self-control on more frequent adherence behaviors. The results are consistent with the idea that family members may share the load of self-control within the family system. The results point to the importance of assessing and intervening within the entire family system to support improved quality of life and better adherence to the medical regimen in adolescents with Type 1 diabetes. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Deborah J. Wiebe
- Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center
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Lansing AH, Turner SL, Osborn PG, Winnick JB, Taheri K, Murray M, Butner J, Wiebe DJ, Berg CA. Academic achievement and metabolic control in adolescents with type 1 diabetes. CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2016.1275641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Sara L. Turner
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Peter G. Osborn
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Joel B. Winnick
- Clearinghouse for Military Family Readiness, Pennsylvania State University, University Park, PA
| | - Kiana Taheri
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Mary Murray
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Jonathan Butner
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Deborah J. Wiebe
- Department of Psychological Sciences, University of California, Merced, Merced, CA
| | - Cynthia A. Berg
- Department of Psychology, University of Utah, Salt Lake City, UT
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Gonzalez JS, Tanenbaum ML, Commissariat PV. Psychosocial factors in medication adherence and diabetes self-management: Implications for research and practice. ACTA ACUST UNITED AC 2017; 71:539-551. [PMID: 27690483 DOI: 10.1037/a0040388] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Diabetes is a chronic illness that places a significant self-management burden on affected individuals and families. Given the importance of health behaviors-such as medication adherence, diet, physical activity, blood glucose self-monitoring-in achieving optimal glycemic control in diabetes, interventions designed and delivered by psychologists hold promise in assisting children, adolescents, and adults with diabetes in improving their health status and lowering their risk of serious complications. This article first provides an overview of diabetes self-management and associated challenges and burdens. Socioeconomic status factors that may influence diabetes management and outcomes are briefly highlighted. We then review the evidence base for select psychosocial factors that may be implicated in diabetes self-management. Modifiable targets of psychological intervention are presented across 3 overarching domains: (a) knowledge, beliefs, and related cognitive constructs; (b) emotional distress and well-being; and (c) behavioral skills and coping. Important methodological issues facing future research are discussed, along with opportunities for psychologists in improving the care and treatment outcomes of individuals and families living with diabetes. In conclusion, we advocate for continued research emphasis on improving psychosocial aspects of living with diabetes, with greater attention to the situational context in which the self-regulatory processes underlying self-management occur. Psychologists have important roles to play in reducing emotional distress, improving patient knowledge, and providing training in behavioral skills to promote successful self-management and to support patient-centered diabetes care. (PsycINFO Database Record
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Winnick JB, Berg CA, Wiebe DJ, Schaefer BA, Lei PW, Butner JE. Metabolic control and academic achievement over time among adolescents with type 1 diabetes. ACTA ACUST UNITED AC 2017; 32:105-117. [PMID: 28080100 DOI: 10.1037/spq0000190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The relation between metabolic control (HbA1c) and achievement (grade point average [GPA]) was examined over a period of 2.5 years (every 6 months) employing a dynamical systems approach that allowed for the examination of whether HbA1c was associated with change in subsequent GPA and vice versa. Metabolic control tends to deteriorate (i.e., with higher HbA1c reflecting poorer metabolic control) during adolescence. It was hypothesized that these higher levels of HbA1c would limit subsequent increases in GPA. The sample included 252 adolescents (Mbaseline age = 12.49 years, SD = 1.53; 53.6% female) with Type 1 diabetes. Mothers' report and school records provided information on relevant demographics and GPA; medical records provided values of HbA1c. Two simultaneous coupled change equations (i.e., examining current values in 1 variable associated with changes in the other) controlling relevant risk indicators (i.e., age, sex, disease duration, insulin delivery method, IQ) revealed higher levels of HbA1c limited increases in GPA. Higher levels of GPA, however, were not associated with change in HbA1c except for 2 instances where moderation existed by disease duration and IQ. Higher GPA was associated with slower increases in HbA1c over time for youth with shorter disease duration and lower IQ. These results affirm the importance of maintaining good metabolic control to facilitate adequate school performance across the adolescent years. Further, the results suggest that factors related to school achievement may protect adolescents who are newly diagnosed or who have low cognitive ability from subsequent deterioration in metabolic control. (PsycINFO Database Record
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Affiliation(s)
- Joel B Winnick
- Department of Educational Psychology, Counseling, and Special Education, Pennsylvania State University
| | | | - Deborah J Wiebe
- Department of Psychological Sciences, University of California, Merced
| | - Barbara A Schaefer
- Department of Educational Psychology, Counseling, and Special Education, Pennsylvania State University
| | - Pui-Wa Lei
- Department of Educational Psychology, Counseling, and Special Education, Pennsylvania State University
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Berg CA, Queen T, Butner JE, Turner SL, Hughes Lansing A, Main A, Anderson JH, Thoma BC, Winnick JB, Wiebe DJ. Adolescent Disclosure to Parents and Daily Management of Type 1 Diabetes. J Pediatr Psychol 2017; 42:75-84. [PMID: 28175323 PMCID: PMC5896607 DOI: 10.1093/jpepsy/jsw056] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/26/2016] [Accepted: 05/26/2016] [Indexed: 11/14/2022] Open
Abstract
Objective To examine how adolescents’ daily disclosure to parents about type 1 diabetes management may foster a process whereby parents gain knowledge and are viewed as helpful in ways that may aid diabetes management. Methods A total of 236 late adolescents (M age = 17.76) completed a 14-day diary where they reported daily disclosure to, and solicitation from, their parents, how knowledgeable and helpful parents were, and their self-regulation failures and adherence; blood glucose was gathered from meters. Results Multilevel models revealed that adolescent disclosure occurred in the context of greater parent solicitation and face-to-face contact and was positively associated with adolescents’ perceptions of parental knowledge and helpfulness. Disclosure to mothers (but not to fathers) was associated with better diabetes management (fewer self-regulation failures, better adherence). Conclusions Adolescent disclosure may be an important way that parents remain knowledgeable about diabetes management and provide assistance that serves to support diabetes management.
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Affiliation(s)
| | - Tara Queen
- Department of Psychology, University of Utah
| | | | | | | | | | | | | | - Joel B. Winnick
- Department of Human Development and Family Studies, Pennsylvania State University
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